Category Archives: Practice Builders

I wonder, I wonder, I wonder how technology will influence/change the nature of my field 10 years from now.

National and International

10 years ago I never would’ve had clients in these states: Arizona, California, Colorado, Illinois, Kentucky, Michigan, Missouri, New York, Tennessee, Texas, Virginia, Washington AND these countries: Afghanistan, Canada (Alberta and Ontario), England, Mexico, Nigeria, Norway, ALL of whom I’ve been able to work with from the comfort of my own office and that they’ve been able to work with me from the comfort of their own homes or offices.

“Continuity of Care” and “Client-Centered” Realized

In the past it was local or nothing. Now my clients can choose who they work with. They can have real “continuity of care” rather than hope they find a good therapist when they move (and as we know, most don’t make that transition to a new therapist successfully, and more than often drop out of counseling altogether). They no longer have to start over with someone new and tell their whole story fresh again. They have the freedom of continuing the work they began. And new clients from these places get to access who they want to work with. It is truly making it more and more client-centered, which is what we believe in this field, but sometimes isn’t realized. Technology is giving my clients more choice and with choice comes power.

I am truly grateful for amazing technology and ALL the brilliant minds that have come together to make this all so “easy.” Due props to all you awesome geeks and nerds out there!

For my colleagues who desire to go out on their own into private practice, speaking business, etc. I highly recommend this GREAT article: How to Survive Your First Year as a Entrepreneur. Love it. Rings so true to my experience as an entrepreneur (minus the prostitutes). Great advice to anyone venturing into the fantastic world of entrepreneurship.

By the way, you still might fail on that first business. But now it’s too late for you. You’re never going back to the pencil factory. You’re an animal, you hunt in the wild, you dig your sharp teeth into flesh and enjoy it, and at the top of the mountain you roar like a lion and everyone cowers in fear.”

Personally, there’s no going back to the pencil factory for me (i.e., mental health agency or working for someone else in my case). LOVE working for self and CREATING!!! Tough, nerve-wracking, fantastic. If you’ve got the passion and heart to put yourself out there and aren’t too risk-averse I highly recommend this crazy wonderful life.

Q: A therapist colleague asked me:

Do you ever say yes to a client’s friend request on Facebook? And if so what are your rules about it? I have some that want to keep in touch with me after I move but I am just not sure and don’t want to make a bad choice but there isn’t much said about ‘internet’ and ‘Facebook’ stuff?”

A: Great question. Yes, I do. And yes, I know there’s some controversy on this topic. I’ve read a lot on the subject and have given it a good deal of thought. Admittedly, for the field as a whole, this is still mostly uncharted territory. But it’s one that isn’t going away, and old school practitioners are going to find it hard to compete if they don’t learn to adapt to where their clients are—which is where the market is.

For me and my clients, I’m all for embracing current technology and how people (our clients) communicate in real life. For example, I also do coaching via phone and Skype with clients all over the country and internationally. Some say it’s not as good as face to face (I agree). However what it does for:

1. Continuity of care for clients is simply phenomenal,
2. Providing greater choice to clients in their selection of providers is unparalleled, especially in rural areas, as well as
3. Greater flexibility and convenience in scheduling (just consider the convenience of a single mother or young couple not needing to arrange for a babysitter).

Face-to-face cannot always provide for these three very significant factors. There are pros and cons for each method.

I’ve always been an early adopter of integrating technology in our field as well as being a proactive marketer of wellness rather than passively waiting for clients to find me. I believe we as therapists have specialized knowledge and skill sets that are too important to just wait in our offices until people’s problems reach the crisis point that they then start searching for a therapist. I’d much rather people get to know a good therapist long before they “need” one… Then when the need arises they don’t have to scramble “hoping” they find someone that will work. The latter does not seem like good client care to me. Giving them the chance to pre-decide way ahead of time is much better for all as it insures a more proper “fit” with client and therapist which predicts greater successful outcomes for both.

So, to answer your question here are a few points (in no particular order and by no means comprehensive) I use on Facebook:

1. First of all, I work with a high functioning clientele, so boundary issues are rarely (haven’t had any yet actually) an issue. If I still worked for a community mental health agency I would very likely not “friend” my clients for the most part, even though they were wonderful people. Generally, in the discussion around where does coaching and therapy begin/leave-off, the thinking is that GAF (Global Assessment of Functioning) scores of 70+ are more “coaching” clients. That is open to debate, but it’s the general thinking on the topic. When I say “high-functioning”, though, that is what I’m talking about;
2. My Facebook page is first and foremost for networking, so I stay mindful that my posts and pics will be seen by clients, colleagues, referrers, as well as friends and family. So is what I post something I’d feel sharing posting on a bulletin board or discussing in a seminar? Yes. Sometimes it’s clinical. Sometimes funny. Sometime personal. The point in both therapy and social networking is to always be real, relevant and relatable;
3. The broad mix of Facebook friends I feel provides the same anonymity and confidentiality that any other public social environment affords, such as the grocery store and the same rules there apply. For example, the client owns the relationship–meaning I won’t acknowledge them as a client unless they want to self-identify publicly in a post that way such as, “You helped our marriage so much. Thanks!” Otherwise as far as anyone else knows they are just another acquaintance. It’s similar if I run into a client in the grocery store–if they come up to me I’m happy to talk. If not, I politely avoid them to protect their privacy. If my kids ask who was that, I just say, “A friend of mine” to protect their confidentiality;
4. Contrary, to conventional practice (which some of the research now supports me) I do believe in a good deal of self-disclosure. Many clients over the years have expressed frustration that they want a great relationship with their spouse or kids but have never seen that modeled in real life. The medium of Facebook and appropriate self-disclosure provides that. I’m by no means THE model, but I am one very real life example of a guy doing his level best at practicing about 80% as a husband and father of what he preaches as a therapist.
5. I’m also pretty down to earth, silly and frank in my Facebook posts. This serves a dual purpose: 1. To remove the stigma of the stuffy, clinical therapist and 2. Markets myself to my ideal clients (ie., those who value plainness and authenticity) and screens out my non-ideal clients (ie., the ones who take themselves too seriously). This leads to a better fit on both sides. Potential clients get to “check me out” in advance and decide whether I will be a good fit for their style and their needs. Yellow Page ads and websites just don’t give the same level of relate-ability or transparency that clients really want and value;
6. After all that, I re-read your question and realized I neglected to directly answer your first question. Yes, I do accept my clients “friend” requests (remember my caveat: I have a high-functioning clientele with good boundaries). I also didn’t mention what is likely obvious: Most people don’t consider Facebook “friends” to be the same as friends in the traditional sense unless their page is strictly limited to immediate friends and family. This is one reason I don’t consider my client who is also my Facebook “friend” as being a dual relationship anymore than I would consider having a friendly conversation with a client I happened to meet at the grocery store a dual relationship.

Now there may be others who will say you should never “friend” clients on Facebook. And they may be right depending on the population they work with or their own preferences. However, for me it’s worked great. Client feedback is they value it. My approach has always to be client-centered and customer-driven. So, bottom line: I’m all about effectiveness. If it works keep doing it. If it doesn’t, don’t.

Your thoughts? Other questions?

Peace,

Jonathan

Tips for new therapists and a Request to my seasoned colleagues

—NOTE: Please excuse typos and incomplete parts you may notice. This post is a rough draft—

A new, young and talented therapist in the field just passed his licensure exam and is going to be working with latency-age children. He asked for some literature and recommendations for working with this population. I LOVE to encourage and mentor the next generation of therapists, as I’m sure you do as well. I’m putting together a few notes, ideas and reading list for him and would value your recommendations as well (for him as well as for me). Just enter your recommendations in the comments below. THANK YOU FOR YOUR INPUT!

While there are MANY things to learn and know about working with this age population, and MANY fantastic books, I would recommend the following as a crash course to cover some of the broad strokes. Knowing that there is limited time to get up to speed, the books with the *asterisks are the ones I would say are the essential first reads. These are all clickable links to Amazon so you can get them right away.

Family Therapy

First and foremost: If you’re working with kids you’re working with families. Learn how to do family therapy—learn how to get comfortable in the chaos that can come with working with multiple people and dyanmics in the same room. Family therapy is your friend. Embrace it. I am amazed about how many therapists have only had one family therapy class in grad school (and no further post-grad training) who then go on to provide family therapy. Yikes! Further, I’ve sadly been amazed how much corrective work I’ve had to do for parents and kids who’ve been to therapists who’ve done “family therapy” that really wasn’t. There are SO many books in this area I could recommend, of course, but this is a 101 Crash Course list.

*Family Therapy Techniques. You can’t go wrong with studying the masters. This book is 30 years old and you’ll be hard-pressed to find better. Minuchin was a family therapy pioneer. You would do well to study any of the family therapy greats: Whitaker, Haley, Madanes, the MRI Group, Milan Systemic, etc.

Working with Kids in Therapy in General

*The Child Psychotherapy Treatment Planner (Practice Planners) is a nuts and bolts idea-generator for when you are wondering what should I do with X situation?

Handbook of Evidence-Based Treatment Manuals for Children and Adolescents is another great go-to guide for getting ideas and strategies and goes into more depth than the first one. I have the first edition. This link is for the 2nd edition published in 2008.

Cognitive-Behavioral Therapy for Impulsive Children, Second Edition, is pretty self-explanatory…

Therapist’s Guide to Clinical Intervention, Second Edition: The 1-2-3′s of Treatment Planning (Practical Resources for the Mental Health Professional), is another great go-to-guide for “How might I approach X problem?” which covers many child/adolescent issues as well.

Play Therapy

*Play in Family Therapy, Eliana Gil. This was one of the best books I got in grad school that I devoured for ideas in working with kids in therapy of all ages.

Filial Therapy is one of the many forms of play therapy. The short version: It’s basically parent training. Train the parent to be the in-home therapist as there’s no one that is better situated in love and proxmity to be the best therapist than the parent is. I’ve done a lot of play, art and sandtray therapy with kids which is great. However, most of my work now with kids is in training the parent(s)…

Parent Training

Parents are interested only so much in developmental theory and your assessment. What they really want is to know WHAT TO DO in real-life practical situations at home and in-the-moment.

*Parenting With Love And Logic, by Jim Fay and Foster Cline. There are many fantastic parenting books out there. This one is worth it’s weight in gold. It’s solid and practical and parent-friendly in a way that empowers both parents and children. It’s easily taught and also deep. I encourage the parents I work with (and new therapists) to learn one book well rather than many poorly or half-way. This is also true for therapeutic models. It’s good to be eclectic and open in therapy. But watered-down versions of solid, research-based models is NOT good for anyone. So for the parent and the therapist LESS IS MORE. I wish I got a kick-back from them–Heaven knows I’ve sold enough of their books over the years for them just by telling parents to go buy them. This is such a great in-the-trenches model developed by a school principal and child pscyhiatrist.

Some more great Love and Logic resources:

• Love and Logic free articles (great for client handouts)
• Free Love and Logic audios and videos. They are funny and practical. It’s great to hear how L&L is actually applied in real examples rather than just reading about it. Plus Jim Fay is just funny and relatable in his delivery.
• Free Funny Parenting Stories audio (good for your own training and your client parents)

Raising An Emotionally Intelligent Child The Heart of Parenting, John Gottman. Gottman was talking about emotional intelligence way before it became a buzzword. Classic solid Gottman stuff.

Before It’s Too Late: Why Some Kids Get Into Trouble–and What Parents Can Do About It, by Stanton E. Samenow (pronounced sam-uh-naw) is a fascinating book by one of the leading clinical forensic researcher written for parents on how to catch and correct anti-social behavior “before it’s too late.”

Divorce

I taught the State’s mandatory divorce parenting class for over a decade. I’ll send you my handout packet I used for that.

Teach the grief process. Teach the importance of co-parenting.

Books:

*Vicki Lansky’s Divorce Book for ParentsVicki Lansky’s Divorce Book for Parents: Helping Your Children Cope with Divorce and Its Aftermath (Lansky, Vicki), I used this for years as the book for my divorce education class. Great, quick reference stuff.

Helping Your Kids Cope with Divorce the Sandcastles Way, M. Gary Neuman with Patricia Romanowski. This is a more in depth book than the above. Both offer great info and strategies for kids and fams.

Stepfamilies

Stepfamilies are THE most common family form. Learn stepfamily dynamics. If you don’t know stepfamily dynamics (I’m amazed how many therapists don’t!) then how will you be able to help the kids and parents you work with navigate a stepfamily successfully? [I do a workshop on this. Give me a call and we can set up a private training if you like on this or any of these areas).

ADHD and Behavior Modification/Shaping Basics

Funny, I've been treating ADHD for years in kids, teens and adults and I don't have any fav books that come right to mind. Hmmm.... Diagnose that. However, a parental fav many of my clients have found useful is: Parenting Children with ADHD: 10 Lessons That Medicine Cannot Teach (APA Lifetools)

I'll send you my draft of my upcoming book: 125 Alternate Solutions to Managing ADHD. This is available as a workshop as well. See the Parent Training section on the Seminars page.

I also teach a Study Smarter, Not Harder: Effective Learning Strategies for teachers, parents and students. You'll certainly be dealing with many bright kids who don't think they are bright because they've never learned how to succeed in school.

I'm happy to do private trainings for you 1:1 on any of these topic areas and/or I could come and do in-service trainings for your agency.

Among the many things we talked about in today’s Networking Group, Mark mentioned a book that sounds promising: Be a Wealthy Therapist: Finally You Can Make a Living While Making a Difference (http://www.beawealthytherapist.com). He’ll be reading it and sharing his take on it with us. One idea he shared was: Try to imagine what it is that wakes your clients up at 4 o’clock in the morning. That becomes your catch phrase for your practice, website, marketing materials etc. He gave the example of Julie de Azevedo-Hank’s (http://www.juliehanks.com) use of this idea with their successful Wasatch Family Therapy (http://www.wasatchfamilytherapy.com) practice. You can visit her sites and see what we mean. I love that idea, and wished I had heard of that years ago when I was trying to figure out my approach as I would’ve been able to nail down my message a lot sooner.

The basic idea is to them how you will answer their pain, not tell them about what you do or about yourself. For example, in my case, instead of “I do marriage counseling” (yawn), “I help people  not only save their marriages, I help them create phenomenally GREAT relationships.” (Wow!) My tagline is “Create GREATness in Your Relationships”. Another example: While Julie treats depression and women’s issues she doesn’t lead with that. Her sites proclaim, “Healing relationships” and  ”Let your best self shine.” In all of these examples people want to hear the solution to their pain and beyond, not just that  you will treat their pain.

We’d all love to hear your practice building ideas. What do you do that’s working for you in your practice?

Conference Notes: I still have to edit this… But here it is rough for now…

Additional notes from the panel discussion: Private Practice Panel, UAMFT Conference

Insights from my colleagues

3 Things: Vic Nelson

1. Ongoing training. Stay sharp through research, education, colleagues, in-services, reading, etc.
2. Innovation. What new and different ways are there for you to leverage your skill sets? Jonathan, for example, does business management consulting with the unique psychological and systemic understandings that only an MFT can bring to an organization. Jonathan also markets himself as a relationship strategist instead of a counselor or therapist because there are lots of therapists but how many “relationship strategists” do you know? That gets people thinking.
3. Effectiveness. Track results and outcomes. Jonathan actually offers an unheard of money-back guarantee for his marriage transformation work.

Thorana Nelson advised: “Be good to your colleagues.”

Others:

• Go to business workshops in the business community. NSA, etc.
•  Confident ≠ cocky. “I’m not conceited, I’m as good as I say I am.” —Will Smith
•  Not “just” a therapist. Take pride and ownership of the unique knowledge and skillsets you possess.
• Say “yes” when asked, “Can you _________?” whether it’s a speaking engagement, new project, etc. Wayne Dyer’s story on grants. Pablo Picasso qoute. How I became a bullying prevention and intervention expert.
• “When I don’t know how to do it I give it to someone else. I have a lot of friends.” —Owner of a successful janitoral business.
• Do columns for local churches’ monthly newsletters.
• Radio talk shows, PTA meetings, speak for organizations monthly meetings.

5/5/5 for 3

(Vic) over 3 months

• 5 contacts a week with potential referral sources (network lunch, EAPs, etc)
• 5x/mo meet with the Top 5 potentials face to face.
• 5 different ways get your name out in the community: Biz, workshops, column, etc.

Referral Sources

• Take care of your referal sources. Call and thank and give feedback and anything you want me to do? and send thank you notes.
• Getting ref sources: answer your ref sources pain vs. telling them about you.
• Rel buidling
• Persistance.

Describe your ideal client: 

Biz model

Aggressive Marketing Mindset, by Jonathan Sherman

• People don’t know I’m there if I don’t tell them.
• website and drive to it!
• Articles
• Follow-up
• collect contacts–use evals
• workshops (free and fee-based)
• Tell people vs. wait for them to come to me

What makes me unique?

• guarantee outcomes
• Rel strategies

What do you like/dislike about your work in private practice?

• Up/down seasons, free schedule, own systems

What has helped you?

• Mentors!!! Reading and live.

Things you wished you had known?

• Increase fee early
• Less fear

Most valuable lessons?

• Unstoppable book
• I had a community MH background and didn’t know how to attract high-functioning, high-paying clients. Never saw myself as a “money-grubbing souless business person.” It wasn’t until I realized that I could help more people by doing a sound business plan than by avoiding intelligent business practices.

Private Health Insureance?

• AAMFT has group insurance
• HSA–keep premium low, high deductible, turns into IRA if money not used (you keep you rmoney vs use it or lose it like a cafeteria plan)

UAMFT Annual Spring conference May 21-22, 2010 

Panel: Shannon S. Boxley, MS, LMFT, Pamela Kings, MS, LMFT, Victor Nelson, STM, LMFT, Jonathan D. Sherman, MS, LMFT & Nancy Webb, MS, LMFT

Pam King compiled these “Tips From the Field” from the above panel members.

Professional Health 

1. Establish a good consulting group. If you practice in isolation you are putting yourself at risk as well as limiting your potential therapeutic impact.
2. Embrace “failure” learn from it.
3. See continuing education clinical skills and business skills
4. Identify your clinical and business resources
5. www.FamilyTherapyResources.net service of AAMFT

Personal Health 

1. Be flexible while maintaining the boundaries that are necessary to keep yourself healthy and assist your clients in the process.
2. Develop a fulfilling practice rather than a full practice
3. Embrace the seasons of your personal/family life as you make business decisions.

Financial Considerations 

1. Remember you are running a business (with all kinds of business expenses); don’t apologize for requesting payment for your services!
2. Be able to offer clients the use of a debit/credit card machine to make payment easy for them.
3. Charge what you’re really worth and for the value your clients are really getting
4. Develop a business mindset and diversify your income streams.

Advertising 

1. Get the word out
2. Change how you think about the money you spend on advertising-a $500/year ad in a phonebook or Psychology Today will be made back in one client in a few sessions, and everything after that is pure profit!
3. Look professional
4. Announce your practice, market your practice-use free media for publicity
5. Maintain an online presence
6. Leverage social media.

Develop and maintain referral sources 

1. Get a business card right away so you have something to leave with new referral contacts.
2. Network outside of your field
3. Identify your main referral sources and market to that audience.

Define your practice 

1. Limit the scope of your practice to a few areas of interest rather than being a generalist
2. Define your practice-Create a niche or specialty
3. Develop systems that work for you
4. Offer more than expected.